Healthcare Provider Details

I. General information

NPI: 1225290844
Provider Name (Legal Business Name): GARY KEITH BARNETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR
CORINTH MS
38834-9321
US

IV. Provider business mailing address

401 ALCORN DRIVE SUITE 2C ATTN CREDENTIALING
CORINTH MS
38834
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1440
  • Fax: 662-293-4334
Mailing address:
  • Phone: 662-293-7266
  • Fax: 662-293-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25335
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR853108
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: